Alprazolam Use & Dependence
Benzodiazepine: Alprazolam (Xanax)
The debate regarding the appropriate use of benzodiazepines began over forty years ago, as the first benzodiazepines were marketed in the early 1960s. Since then, this class of medicine has been associated with abuse, dependence, and uncomfortable withdrawal. In their article, “Alprazolam Use and Dependence: A Retrospective Analysis of 30 Cases of Withdrawal,” Bill Dickinson, D.O. and colleagues focus on one of the most popular benzodiazepines: alprazolam (Xanax).1 In 1981, the Upjohn Company began to market alprazolam, with its recommended usage being for anxiety. Seven years later, it became the number one selling benzodiazepine, with its list of usages growing, including panic disorder, agoraphobia, social phobia, and adverse schizophrenic symptoms. The product’s information pamphlet stated that there were few side effects associated with alprazolam, as long as dosage was followed correctly and reduction was no faster than 0.5mg every three days.3
Adverse Effects of Alprazolam
Dickinson and colleagues found this to be untrue.1 In fact, the number of complaints regarding the use of alprazolam has increased since its introduction.1 Some adverse effects reported are hostility, rebound insomnia, major depression, amnesia, aggressive and violent behavior, mania, jaundice, and altered liver function. Withdrawal effects have been known to include rebound anxiety, delirium, psychosis, mania, paranoia, and increased panic attacks. During the year of 1989, Dickinson and colleagues noticed an increase in alprazolam withdrawal at their treatment center, the Chemical Dependency Recovery Program at Kaiser Permanente Hospital in Fontana, California.1 Also, those withdrawing from alprazolam were known to have a long detoxification stage, severe withdrawal symptoms, and require a good amount of staff time, compared with other detoxing patients.1
Detoxing from Alprazolam
Dickinson and colleagues reviewed 30 cases of alprazolam withdrawal in patients admitted for detoxification between October 1986 and May 1989.1 Overall, it was found that 27 of the patients, or 90 percent, had their alprazolam dosage increased professionally over time.1 Of those, 21, or 70 percent, had tried, unsuccessfully, to cut down on their dosage.1 Interestingly enough, 24 patients (80 percent) were taking alprazolam at therapeutic dosages, suggesting that more caution should be used when prescribing the medicine, as dependence develops even at therapeutic levels.1 Dickinson and colleagues reported that withdrawal was a “tedious” process.1 The medicine’s pamphlet recommended decreasing the medicine no faster than 0.5mg per day; however, Dickinson and colleagues found even the recommendation to be too quick,1 as many studies have recommended a much slower rate. In fact, one patient of Dickinson’s needed to be placed on a tapering schedule of 0.25mg every two weeks.1 If tapering occurs too fast, most patients will feel uncomfortable withdrawal symptoms.1
Therefore, it is important for psychiatrists and prescribing clinicians to review the patient’s medical history for dependence, which will help ensure that alprazolam is prescribed in appropriate situations. Also, patients taking benzodiazepines should be monitored closely for abuse and dependence, and tapering off the medicine should be slow and comfortable.
 Dickinson, B.; Rush, PA; and Radcliffe, AB. (1990, May). Alprazolam Use and Dependence: A Retrospective Analysis of 30 Cases of Withdrawal. In Addiction Medicine [Special Issue]. West J Med; 152: 604-608.
 WHO Review Group: Use and abuse of benzodiazepines. Bull WHO 1983;61:551-562.
 Product Insert, Xanax. Kalamazoo, Mich, Upjohn Company, 1985.
 Noyes R Jr, DuPont RL Jr, Pecknold JC, et al: Alprazolam in panic disorder and agoraphobia: Results from a multicenter trial. Arch Gen Psychiatry 1988; 45:423-428.
 Reich J, Yates W: A pilot study of treatment of social phobia with alprazolam. Am J Psychiatry 1988; 145:590-594.
 Csernansky JG, Riney SJ, Lombrozo L, et al: Double-blind comparison of alprazolam, diazepam, and placebo for the treatment of negative schizophrenic symptoms. Arch Gen Psychiatry 1988; 45:655-659.
 Kales A, Bixler EO, Vela-Bueno A, et al: Alprazolam: Effects on sleep and withdrawal phenomena. J Clin Pharmacol 1987; 27:508-515.
 Browne JL, Hauge KJ: A review of alprazolam withdrawal. Drug Intell Clin Pharm 1986; 20:837-841.
 Ayd FJ: Alprazolam witAhdrawatl. Drug Ther Newslett 1986; 21:28. alprazolam.